Shared understanding: Predicting home hospice nurse-cancer family caregiver communication similarity.

Abstract

40 Background: In cancer home hospice, families provide 24/7 care with support from a nurse-led hospice team. Effective patient-caregiver-nurse communication can facilitate a “shared understanding,” resulting in better patient caregiver outcomes. Shared understanding may be evidenced by high similarity in language usage/meaning. Objective: Describe communication caregiver-nurse similarity (relatedness in word usage/meaning) in cancer home hospice using latent semantic analysis (LSA) and to identify nurse communication processes, confidence, and preferences that predict communication similarity. Methods: As part of a larger study, nurse home hospice visits to spouse cancer caregivers were audio recorded. Interaction analysis was used to quantify caregiver and nurse emotion talk, nurse partnering, and nurse dominance (ratio of total nurse/caregiver talk). Nurses completed questionnaires to capture preference for patient oriented care and confidence in their communication. Verbatim transcripts were analyzed using LSA, a tool that assesses the similarity of communication (range 0-1 where higher scores indicate greater similarity). Descriptive statistics and bivariate correlations were calculated. Results: 31 nurse-caregiver home hospice interactions were analyzed. Nurses were female, average age 44.03 (SD = 9.8), with an average 14.6 years experience. Spouse caregivers were 77% female, average age 64.7 (SD = 10.9). The average LSA score was .83 (range = .66-.89). Higher LSA values were significantly associated with more nurse partnering (r = .36, p = .05) and lower nurse dominance (r = -.39, p = .03), but not caregiver or nurse emotion talk (ps > .05). Higher LSA values also predicted more nurse-reported preference for patient-oriented care (r = -.75, p < .01) and lower nurse communication confidence (r = -.46, p = .01). Conclusions: Our findings suggest that hospice nurses who are more patient-oriented, listen to and encourage caregivers’ concerns are more likely to use concordant meaning and language usage in their home hospice visits. Further research should examine if a nurse’s use of language similarity strategies improve caregiver understanding, competency and satisfaction with care.